Cosmetic surgery, in its true sense, is an elective procedure that is performed to reshape or enhance body parts a patient may find unflattering. Since cosmetic surgery has an intrinsic aesthetic intent, it is usually not covered by health insurance. The argument put forth by insurance firms is that a person can very well do without cosmetic surgery, and the procedure is used for mere beautification instead of being a life saving surgery. On the other hand, reconstructive surgery is generally covered by health insurance, though the extent of coverage may vary a lot from one case to another.

In many ways, the answer to the insurance question lies in discerning whether the plastic surgery procedure is cosmetic or reconstructive. For instance, abdominoplasty (or tummy tuck), when performed on an obese patient to guard the patient against heart problems, is eligible for health insurance. Breast reduction surgery, when carried out with the intent of reducing weight of the breasts to curtail orthopedic pain, is typically covered by health insurance. On the other hand, breast implants or augmentations are performed with the aesthetic aspect in mind and, therefore, don’t normally qualify for an insurance.

There is a fine line dividing the two categories of plastic surgery, namely cosmetic and reconstructive surgery, as far as eligibility for insurance is concerned. For instance, eyelid surgery, when performed to attain an aesthetic enhancement is considered cosmetic and ineligible for insurance. The same procedure may be covered by insurance if the eyelids are drooping to the extent of obscuring a patient’s vision. The hard fact remains that most of the plastic surgery procedures are performed with an aesthetical intent, in order to enhance alluring portions of the body.

To summarise, plastic surgery that is performed to improve function instead of aesthetics is normally eligible for an insurance cover. However, it’s best to discuss your case with an insurance agent, in order to determine if you are eligible for an insurance cover. For more articles like this, bookmark www.CosmeticSurgeryInsurance.net

Author: Nicola Kennedy

Health insurance policies can vary on what is considered a covered medical procedure. Most insurance companies follow the definitions given by the AMA (American Medical Association) and the ASPS (American Society of Plastic Surgeons) which state that there are two types of surgery when discussing plastic surgery - reconstructive and cosmetic surgery. Luckily, there are guidelines insurance companies must follow when it comes to defining what is considered reconstructive and what is considered cosmetic.

Reconstructive Surgery

Reconstructive surgery refers to surgery performed on abnormal structures caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease. These typically include;

Abdominal Surgery: If performed to improve or eliminate health problems such as back pain, sores, hernia, rashes, or to help improve your ability to walk normally.

Breast Surgery: If performed to correct asymmetry, reduce large breasts causing health problems, reconstruction due to loss, congenital absence (born with only one breast), or to reduce large male breasts.

Ear Surgery: If performed to correct deformed ears by birth, disease, or injury.

Eyelid Surgery: If performed to correct drooping eyelids that are causing vision problems or correct eyelids that are turned in an abnormal way.

Facial Surgery: If performed to balance the appearance if caused by paralysis, or to treat deformities in the facial muscles, head, or neck.

Hand Surgery: If performed to treat carpal tunnel syndrome, Dupuytren’s contracture, nerve injuries, tendon injuries, fused fingers, or other deformities.

Nasal Surgery: If performed to correct deformities resulting from birth, disease, or problems with breathing.

Cosmetic Surgery

Cosmetic surgery is the reshaping of normal structures on the body to improve the self-esteem or appearance of a patient. These typically include physical improvements that are not medically necessary. Such as breast enlargement procedures, nose jobs (rhinoplasty), face lifts, hair transplants or laser hair removal, elimination of spider veins other such ‘appearance’ type medical procedures.

Researching Your Procedure

Read your health insurance plan booklet. You will likely find quick answers about surgeries covered, the appeals process and your expected deductible for the procedure.

Every health insurance company has a list of pre-approved medical procedures. So the direct method of contacting your health insurance provider will save you a lot of time when finding out if the exact procedure you need to have, or would like to have, is covered. Ask about exceptions, rule changes or special considerations. If possible, ask them to mail or fax you an approval letter or document outlining the coverage of the procedure you are asking about.

When speaking with your health insurance PPO or HMO provider, make sure you understand all details. Some insurance companies may cover the initial operation, but not the "post-op" complications or touch-ups. Some may not cover the surgery but will protect you in case of problems later on. Some may just cover prescriptions and short-term disability.

Before any type of surgery, discuss the procedure with your doctor and insurance carrier to determine what coverage, if any, you can expect.

Author: Jason Perry

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